Green tea intake lowers fasting serum total and LDL cholesterol
in adults: a meta-analysis of 14 randomized controlled trials1–4
Xin-Xin Zheng, Yan-Lu Xu, Shao-Hua Li, Xu-Xia Liu, Rutai Hui, and Xiao-Hong Huang
ABSTRACT
Background: The effect of green tea beverage and green tea extract
on lipid changes is controversial.
Objective: We aimed to identify and quantify the effect of green tea
and its extract on total cholesterol (TC), LDL cholesterol, and HDL
cholesterol.
Design: We performed a comprehensive literature search to identify
relevant trials of green tea beverages and extracts on lipid profiles in
adults. Weighted mean differences were calculated for net changes
in lipid concentrations by using fixed-effects or random-effects
models. Study quality was assessed by using the Jadad score, and
a meta-analysis was conducted.
Results: Fourteen eligible randomized controlled trials with 1136
subjects were enrolled in our current meta-analysis. Green tea con-
sumption significantly lowered the TC concentration by 7.20 mg/dL
(95% CI: 28.19, 26.21 mg/dL; P , 0.001) and significantly low-
ered the LDL-cholesterol concentration by 2.19 mg/dL (95% CI:
23.16, 21.21 mg/dL; P , 0.001). The mean change in blood HDL-
cholesterol concentration was not significant. Subgroup and sensi-
tivity analyses showed that these changes were not influenced by the
type of intervention, treatment dose of green tea catechins, study
duration, individual health status, or quality of the study. Overall, no
significant heterogeneity was detected for TC, LDL cholesterol, and
HDL cholesterol; and results were reported on the basis of fixed-
effects models.
Conclusion: The analysis of eligible studies showed that the adminis-
tration of green tea beverages or extracts resulted in significant reduc-
tions in serum TC and LDL-cholesterol concentrations, but no effect on
HDL cholesterol was observed. Am J Clin Nutr 2011;94:601–10.
INTRODUCTION
Cardiovascular disease (CVD) is a leading cause of morbidity,
mortality, and disability worldwide (1). Hyperlipidemia, which
results from abnormalities in lipid metabolism, leads to the
development of atherosclerotic plaques and is one of the key risk
factors of CVD (2). Risk of heart attack is 3-fold higher in
subjects with hyperlipidemia than in subjects with normal lipid
status (3), whereas a 1% decrease in serum cholesterol has been
shown to reduce risk of CVD by 3% (1). With the increasing
incidence of hyperlipidemia, more and more consumers are
aware of the effects of what they eat and drink on their blood lipid
profiles.
Green tea is a widely consumed beverage worldwide and is
traditionally used in Asian countries as a medication. Green tea is
Am J Clin Nutr 2011;94:601–10. Printed in USA. Ó 2011 American Society for Nutrition
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produced from fresh leaves of Camellia sinensis and is not
traditionally fermented. Green tea contains antioxidants and
other beneficial nutrients such as protein, carbohydrates, min-
erals, vitamins, and flavonoid-like polyphenols (4). Epidemio-
logic studies have reported an inverse relation between green tea
consumption and CVD risk. Subjects who drink .2 cups of
green tea/d had lower plasma total cholesterol (TC) concen-
trations and have been shown to reduce their risk of death from
CVD by 22–33% (5, 6). In vivo and in vitro studies have shown
that green tea catechins (which belong to the family of flavonols
and serve as an essential component of green tea), exert a car-
dioprotective effect via multiple mechanisms (7–10) including
the inhibition of oxidation, vascular inflammation, thrombo-
genesis, and improvement in blood lipid concentrations.
Recent animal studies have revealed that green tea catechins
could inhibit key enzymes involved in lipid biosynthesis and
reduce the intestinal absorption of TC, thereby improving blood
lipid profiles (9, 10). Because of promising results in preclinical
models, a substantial number of clinical trials have been per-
formed to investigate the effect of green tea beverages and
extracts on lipid profiles of subjects with cardiovascular-related
diseases as well as of healthy individuals (11–24). However,
results of these trials were inconsistent, and sample sizes were
relatively modest. As a result, the precise effect of green tea on
lipid profiles has not been established to our knowledge.
Therefore, we conducted a meta-analysis of all published ran-
domized controlled trials (RCTs) that investigated the effects of
green tea on blood cholesterol, including TC, LDL cholesterol,
and HDL cholesterol.
1
From the Key Laboratory for Clinical Cardiovascular Genetics and
Sino-German Laboratory for Molecular Medicine (X-XZ, S-HL, X-XL, and
RH) and the Department of Cardiology (X-XZ, Y-LX, S-HL, RH, and
X-HH), Cardiovascular Institute and FuWai Hospital, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China.
2
X-XZ and Y-LX contributed equally to this article.
3
Supported by the Ministry of Science and Technology of China with
a grant of the National High-Tech Research and Development Program of
China (to X-HH).
4
Address correspondence to X-Ho Huang, Cardiovascular Institute and Fu-
Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Med-
ical College, 167 Beilishilu, Beijing 100037, China. E-mail: huangxhong12@
gmail.com; or R Hui, Cardiovascular Institute and FuWai Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, 167
Beilishilu, Beijing 100037, China. E-mail: huirutai@gmail.com.
Received December 21, 2010. Accepted for publication May 16, 2011.
First published online June 29, 2011; doi: 10.3945/ajcn.110.010926.
601
602 ZHENG ET AL
METHODS
Search strategy
According to the Quality of Reporting of Meta-analyses, we
systematically searched PubMed (http://www.ncbi.nlm.nih.gov/
pubmed; from 1967 to August 2010), Embase (http://www.embase.
com; from December 1977 to 2010), the Cochrane Library database
(http://www.cochrane.org), and reviews and reference lists of rel-
evant articles by using the text key words tea, green tea, green tea
extract, tea polyphenols, catechin, EGCG, and camelia sinensis,
which were paired with the following words: blood lipid, blood
cholesterol, low-density lipoprotein cholesterol, or high-density
lipoprotein cholesterol. The search was restricted to English-lan-
guage reports of clinical trials in adult humans. In addition,
a manual search of references from reports of clinical trials or
review articles was performed to identify relevant trials. Attempts
were also made to contact investigators for unpublished data.
Study selection
Studies were selected for this analysis if they met the following
criteria: 1) subjects consumed a green tea beverage or extract for
.2 wk, 2) the study was an RCT in human adults with either
a parallel or crossover design, 3) the starting and endpoint lipid
concentrations (TC, LDL cholesterol, and HDL cholesterol)
were available, 4) food-intake control regimens of experimental
groups were consistent with those of control groups, 5) green tea
extract was not given as part of a multicomponent supplement in
either experimental or control groups, and 6) blood samples
were obtained from fasting subjects.
Quality assessment
The assessment of quality characteristics used the following
criteria 1) randomization, 2) concealment of treatment alloca-
tion, 3) participant masking, 4) researcher masking, 5) reporting
of withdrawals, 6) generation of random numbers, 7) and re-
porting of industry funding. The Jadad score was also introduced
to evaluate the quality of the studies. Trials scored one point for
each area addressed in the study design (randomization, blind-
ing, concealment of allocation, reporting of withdrawals, and
generation of random numbers) with a possible score of between
0 and 5 (highest level of quality) (25). Higher numbers repre-
sented a better quality (Jadad score 4).
Data extraction
The search, data extraction, and quality assessment were
completed independently by 2 reviewers (X-XZ and Y-LX)
according to inclusion criteria. Any discrepancies between the 2
reviewers were resolved through a discussion until a consensus
was reached. Study characteristics (including authors, publica-
tion year, sample size, study design, study duration, dose, and
type of intervention), population information (sex and initial
healthy status), and baseline and final concentrations or net
changes of TC, LDL cholesterol, and HDL cholesterol were
extracted. Extracted data were converted to conventional units
(eg, for TC concentrations, 1 mmol/L converted to 38.6 mg/dL).
For multiarm studies, only intervention groups that met inclusion
criteria were used in this analysis (26). If blood lipid concen-
trations were reported several times in different stages of the
trials, only final records of lipid concentrations at the end of the
trials were extracted for the meta-analysis.
Data synthesis and analysis
Net changes in each of the study variables, which were cal-
culated from baseline and follow-up means and SDs (follow-up
minus baseline) were used to estimate the principle effect. When
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SDs were not directly available, they were calculated from SEs or
CIs. In instances in which variances for net changes were not
directly reported, they were calculated from CIs, P values, or
individual variances from the green tea group and control group.
For trials in which variances for paired differences were sepa-
rately reported for each group, a pooled variance for the net
change was calculated by using standard methods. In addition, the
change-from-baseline SDs were also imputed by using correlation
coefficient methods referenced in the Cochrane Handbook for
Systematic Reviews of Interventions (26). We assumed a correla-
tion coefficient of 0.68 (26). For one study (12) in which medians
and interquartile ranges were reported, the width of the inter-
quartile range was ’1.35 SD, and the median was approximately
the mean (26).
Our meta-analysis and statistical analyses were performed with
STATA (version 10; StataCorp, College Station, TX). Weighted
mean differences and 95% CIs were calculated for net changes in
lipid values. The statistic heterogeneity of treatment effects be-
tween studies was formally tested with Cochran’s test (P , 0.1).
The I2 statistic was also examined, and we considered I2 . 50%
to indicate significant heterogeneity between trials (27). Results
were obtained from a fixed-effects model if no significant het-
erogeneity was shown, and a random-effects model was selected
for the analysis if significant heterogeneity was shown (28).
Publication bias was assessed with funnel plots and the Egger’s
regression test. To examine the effects of factors on the primary
outcomes and identify the possible source of heterogeneity within
these studies, previously defined subgroup analyses were per-
formed (type of intervention, catechins dose, health status, study
duration, and Jadad score). Additional sensitivity analyses were
also performed according to the Cochrane Handbook for Sys-
tematic Reviews of Interventions (26).
RESULTS
Results of literature search
The method used to select studies is shown in Figure 1. A total
of 805 potentially eligible articles were initially identified, and
778 articles were excluded because they were not clinical trials
or the interventions were not relevant to the purpose of the
current meta-analysis. Therefore, 27 potentially relevant articles
were selected for detailed evaluation (11–24, 29–41). From the
overall pool of full-text articles, 13 articles were excluded from
the analysis. The duration of the experiment was ,2 wk for 5 of
the trials (31, 32, 36, 39, 40), whereas 3 of the trials did not
report relevant outcomes (29, 37, 38). Three articles lacked
sufficient details for inclusion in meta-analysis (34, 35, 41). In
one study, blood samples were collected from subjects who were
not fasting (30). Another article was excluded because a low-fat
 GREEN TEA LOWERS CHOLESTEROL
FIGURE 1. Flowchart showing the number of citations retrieved by
individual searches of trials included in the review.
diet was only used in the control group, and the results may have
been confounded by the inappropriate study design (33).
Study characteristics
Fourteen eligible RCTs with 1136 subjects were enrolled in the
meta-analysis (11–24). Characteristics of the trials are shown in
Table 1. The work of Princern et al (24) was separated into 2
trials (effects of green tea beverage and green tea extract on
plasma lipid profiles). The trials varied in size from 20 to 240
subjects. The study duration varied from 3 wk to 3 mo (median:
12 wk). Doses of green tea catechins in the treatment group
ranged from 150 to 2500 mg/d (median: 625 mg/d). Of the 14
trials used in the meta-analysis, 5 trials were conducted in healthy
adults (14, 15, 22–24), and 5 trials were conducted in overweight
to obese adults (12, 13, 17, 18, 21). The other studies investigated
the effects of green tea consumption in patients with cardiovas-
cular risks such as hypercholesterolemia (11, 19) or diabetes (16,
20). A green tea beverage was tested in one-half of trials (7 of 14
trials; 11, 16, 17, 19–21, 23), and a green tea extract capsule was
used in the remaining 7 trials (12–15, 18, 22, 24). Most of the
trials (12 trials) adopted parallel study designs (12–15, 17–24),
whereas 2 trials used crossover designs (11, 16). Twelve trials
were double-blinded trials (11–15, 17–23), and 10 trials were
placebo-controlled trials (11–15, 17–19, 23, 24). A low-fat diet
was fed in 2 trials (11, 19), and one trial used a low-energy diet
(13). In the other trials, investigators attempted to maintain the
603
usual lifestyles of participants. In 3 trials (17, 18, 23) of the in-
cluded 14 trials, mild side effects were reported such as mild skin
rashes, gastric upset, abdominal bloating. No side effects were
reported in 7 trials (12, 14, 15, 19, 20, 22, 24). In the remaining 4
trials (11, 13, 16, 21), reports of side effects were unclear.
Data quality
Results of the validity of included trials are presented in Table
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2. The study qualities of selected trials were diverse; 3 trials (12,
17, 20) were classified as high quality (Jadad score 4) and 11
trials (11, 13–16, 18–22, 24) were low quality (Jadad score of 2
or 3). Allocation concealment was clearly adequate in only one
study (17). Two trials (12, 17) reported the generation of random
numbers. Details of dropouts were reported in 12 trials (12, 14–
24). Two studies (19, 20) received industry funding.
Effect of green tea on lipid concentrations
Primary outcome measures were changes in TC, LDL cho-
lesterol, HDL cholesterol between baseline and final concen-
trations because of green tea beverage and green tea extract
supplementation. The results for TC were reported in 14 com-
parisons from 13 studies that represented 949 participants, and the
mean change in TC concentrations was significantly reduced in
subjects supplemented with green tea (27.20 mg/dL; 95% CI:
28.19, 26.21 mg/dL; P , 0.001) than in controls. Heterogeneity
was not shown for this outcome (heterogeneity chi-square 14.30,
I2 = 9.1%, P = 0.353; Figure 2). The mean change in LDL-
cholesterol concentrations was reported in 11 comparisons from
10 studies that represented 853 participants and was significantly
decreased by 2.19 mg/dL (95% CI: 23.16, 21.21 mg/dL; P ,
0.001) in intervention groups than in control arms. No heteroge-
neity was observed for this outcome (heterogeneity chi-square =
13.41, I2 = 25.4%, P = 0.201; Figure 3). The results of blood
HDL cholesterol were calculated in 12 comparisons from 11
studies that included 998 subjects. For intervention groups, the
mean change in blood HDL-cholesterol concentrations showed
a favorable trend, but it was not significant (+0.25 mg/dL; 95%
CI: 20.73, 1.23 mg/dL; P = 0.62). No heterogeneity was detected
for this outcome (heterogeneity chi-square = 13.36, I2 = 17.7%,
P = 0.270; Figure 4).
Subgroup analyses were conducted to explore the dose-effect
relation, study-duration effects, health-status effects, as well as
differences between drinking green tea and taking green tea
extracts. The consumption of catechins was divided into low dose
(,625 mg/d) and high dose (625 mg/d). The time to follow-up
for the assessment of lipid-lowering therapy varied from 3 wk to
3 mo, and thus, a subgroup analysis was performed by dividing
the follow-up duration into a shorter-term subgroup (,12 wk)
and a longer-term subgroup (12 wk).
Subgroup analyses showed that significant reductions of TC and
LDL cholesterol were not influenced by the type of intervention
(drinking green tea or taking green tea supplement). Analyses also
showed that TC and LDL cholesterol were significantly decreased
in the lower– and higher–catechin consumption groups. Green tea
significantly reduced TC and LDL cholesterol in healthy subjects
and in participants with cardiovascular risks. In the shorter- and
longer-term subgroups, significant reductions in TC and LDL
cholesterol were shown. We also stratified studies according to the
TABLE 1 604
Characteristics of 14 included randomized controlled trials1
Author, publication year Study No. of Side
(reference no.) design subjects (M/F) Population Duration Tea group Control group effect Concurrent lifestyle modification

Batista et al, 2009 (11) Double-blinded 33 (5/28) Hypercholesterolemic 8 wk 250 mg GTE capsules Placebo capsules NR Maintain low-fat diet; no vitamin
crossover patients, 21–71 y (catechins NR) supplement
of age
Chan et al, 2006 (12) Double-blinded 34 (0/34) Obese women with 3 mo Green tea capsules Placebo capsules No Limit caffeine; nutritional consults
parallel PCOS, 25–40 y (661 mg catechins)
of age
Diepvens et al, 2006 Double-blinded 46 (0/46) Overweight women, 12 wk GTE capsules (1207 Placebo (maltodextrin) NR Maintain low-energy diet; limit 3
(13) parallel 19–57 y of age mg catechins) capsules cups of coffee/d
Frank et al, 2009 (14) Double-blinded 33 (33/0) Healthy men, 18–55 y 3 wk Aqueous GTE capsule Placebo (maltodextrin) No Maintain usual diet and exercise,
parallel of age (714 mg catechins) capsules limit tea and coffee 3 cups/d
Freese et al, 1999 (15) Double-blinded 20 (0/20) Healthy nonsmoking 4 wk 3 g GTE capsules Placebo (saccharose, No Rich in linoleic acid diet
parallel women, 23–50 y (810 mg catechins) microcrystalline,
of age cocoa) capsules
Fukino et al, 2008 (16) Open-label 60 (51/9) Patients with diabetes 2 mo GTE powder packets No intervention NR Maintain usual diet
crossover or prediabetes, 32–73 y (456 mg catechins)
of age
Hsu et al, 2008 (17) Double-blinded 78 (0/78) Obese women, 16–60 y 12 wk 1200 mg GTE capsules Placebo (cellulose) Yes Maintain normal diet
parallel of age (491 mg catechins) capsules
Maki et al, 2009 (18) Double-blinded 128 (67/61) Overweight or obese 12 wk 500 mL green tea Placebo beverage Yes Maintain normal diet, limit 2
parallel adults, total cholesterol beverage (625 mg caffeinated beverages/d
200 mg/dL, 21–65 y catechins)
of age
Maron et al, 2003 (19) Double-blinded 220 Patients with mild- 12 wk 375 mg GTE capsule Placebo (inert No Maintain low–saturated fat diet
ZHENG ET AL

parallel to-moderate (150 mg catechins) ingredients) capsules

hypercholesterolemia
Nagao et al, 2009 (20) Double-blinded 43 (18/25) Patients with diabetes 12 wk 340 mL green tea 340 mL green tea No Maintain usual diet and exercise
parallel (583 mg catechins) (96 mg catechins)
Nagao et al, 2007 (21) Double-blinded 240 (140/100) Adults with visceral 12 wk 340 mL green tea 340 mL green tea NR Maintain usual diet and exercise;
parallel fat-type obesity, 25–55 y beverage (583 mg beverage (96 mg limit medications or supplements
of age catechins) catechins) that influence lipid or carbohydrate
metabolism
Nagao et al, 2005 (22) Double-blinded 35 (35/0) Healthy men, 24–46 y 12 wk 340 mL GTE/oolong tea 340 mL oolong tea No 2 planned meals/d; no tea or food
parallel of age beverage (690 mg beverage (22 mg high in catechins
catechins) catechins)
Nantz et al, 2009 (23) Double-blinded 108 (44/64) Healthy, 21–50 y of age 3 wk 400 mg GTE capsules Placebo (maltodextrin) Yes Maintain normal diet and exercise;
parallel (320 mg catechins) capsules limit tea 1 cup/d
Princen et al, 1998 (24) Single-blinded 30 (15/15) Healthy, 34 6 12 y 4 wk 900 mL green tea Placebo (mineral water) No Limit milk in tea, 2 cups of fruit
parallel of age (852 mg catechins) juice or tea, 2 oranges daily
Princen et al, 1998 (24) Single-blinded 28 (13/15) Healthy, 34 6 12 y 4 wk 9 g GTE capsules Placebo (mineral water) No Limit milk in tea, 2 cups of fruit
parallel of age (2500 mg catechins) juice or tea, 2 oranges daily
1
GTE, green tea extract; NR, not reported; PCOS, polycystic ovarian syndrome.

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 GREEN TEA LOWERS CHOLESTEROL 605
TABLE 2
Validity of included studies
Allocation Masking of Masking of Generation of random Reporting of Industry Jadad
Reference concealment participants researchers number reported withdrawals funding score

Batista et al (11) Unclear Yes Yes No No No 2

Chan et al (12) Inadequate Yes Yes Yes Yes No 4
Diepvens et al (13) Unclear Yes Yes No No No 2
Frank et al (14) Unclear Yes Yes No Yes No 3
Freese et al (15) Unclear Yes Yes No Yes No 3

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Fukino et al (16) Unclear No No No Yes No 2
Hsu et al (17) Adequate Yes Yes Yes Yes No 5
Maki et al (18) Unclear Yes Yes No Yes No 3
Maron et al (19) Inadequate Yes Yes No Yes Yes 3
Nagao et al (20) Unclear Yes Yes No Yes Yes 3
Nagao et al (21) Inadequate Yes Yes No Yes No 3
Nagao et al (22) Unclear Yes Yes No Yes No 3
Nantz et al (23) Unclear Yes Yes Yes Yes No 4
Princen et al (24) Unclear Yes No No Yes No 2

Jadad score (,4 or 4). Significant reductions in TC and LDL Sensitivity analysis showed that the significance in the pooled
cholesterol were shown in the low- and high-score subgroups. No changes in TC, LDL cholesterol, and HDL cholesterol were not
significant changes in HDL cholesterol were observed in any altered after the imputation correlation coefficient of 0.5. Sensitivity
subgroup. Results are summarized in Table 3. analysis that excluded low-quality studies (11, 13–16, 18–22, 24)

FIGURE 2. Meta-analysis of effects of green tea consumption on total cholesterol (TC) compared with control arms. Sizes of data markers indicate the
weight of each study in the analysis. WMD, weighted mean difference (the result was obtained from a fixed-effects model).
606
FIGURE 3. Meta-analysis of effects of green tea consumption on LDL cholesterol compared with control arms. Sizes of data markers indicate the weight of
each study in the analysis. WMD, weighted mean difference (the result was obtained from a fixed-effects model).
showed that significant results were not influenced concerning TC,
LDL cholesterol, and HDL cholesterol [TC concentration: 23.05
mg/dL (95% CI: 26.62, 0.53 mg/dL), P 0.758; LDL-cholesterol
concentration: 25.25 mg/dL (95% CI: 28.54, 21.95 mg/dL),
P = 0.053; HDL-cholesterol concentration: 2.36 mg/dL (95%
CI: 20.36, 5.08 mg/dL); P = 0.833]. The removal of 2 trials (19,
20) with industry funding did not change the final results [TC
concentration: 27.16 mg/dL (95% CI: 28.16, 26.17 mg/dL);
P = 0.359; LDL-cholesterol concentration: 22.19 mg/dL (95%
CI: 23.16, 21.21 mg/dL); P = 0.201; HDL-cholesterol con-
centration: 0.06 mg/dL (95% CI: 20.98, 1.11 mg/dL); P =
0.263]. The results are also shown in Table 3. Overall, no sig-
nificant heterogeneity was shown for TC, LDL cholesterol, and
HDL cholesterol, and the results were reported on the basis of
fixed-effects models.
Publication bias
Funnel plots and Egger’s tests indicated no significant publi-
cation bias in the meta-analyses of TC, LDL cholesterol, and HDL
cholesterol (TC Egger’s test: P = 0.148; LDL cholesterol Egger’s
test: P = 0.385; HDL cholesterol Egger’s test: P = 0.679).
DISCUSSION
Our meta-analysis showed that both green tea beverages and
green tea extract supplementation significantly reduce blood TC
and LDL-cholesterol concentrations but did not affect HDL
cholesterol concentrations. Subgroup and sensitivity analyses
ZHENG ET AL
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showed that these changes were not influenced by the type of
intervention, treatment doses of green tea catechins, study du-
ration, individual health status, or quality of the study.
A large population-based study that involved .40,000 middle-
aged Japanese revealed that, compared with no tea drinking,
habitual green tea consumption [an average of .2 cups (’17
oz)/d for 10 y] was associated with a lower risk of death from
CVD (5). The beneficial effects of green tea on cardiovascular
health may be due to the high concentration of green tea cat-
echins, which have been proven to favorably modulate the
plasma lipid profile. These small molecules exert a variety of
physiologic actions and, thus, affect lipid metabolism.
Animal experiments indicated that the inhibition of cholesterol
absorption may be the mechanism to explain the cholesterol-
lowering effects of green tea. Catechins with gallate esters were
shown to interfere with the biliary micelle system in the lumen of
the intestine by forming insoluble co-precipitates of cholesterol
and increasing the fecal excretion of cholesterol (42). This ap-
parent decrease in cholesterol absorption and reduction in liver
cholesterol concentrations lead to an increase of LDL-receptor
expression and activity (9). This cell-surface protein is present on
the outer surface of most cells, but in particular liver cells, it can
remove cholesterol-carrying LDL from the circulation. Studies in
animals have provided evidence that green tea extracts and their
catechin constituents can reduce plasma, liver, and thoracic aorta
cholesterol and up-regulate hepatic LDL receptors (9, 10). Bursill
and Roach (9) and Bursill et al (10) have concluded that the
administration of green tea extract was able to significantly in-
crease both the LDL-receptor binding activity and relative
 GREEN TEA LOWERS CHOLESTEROL 607

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FIGURE 4. Meta-analysis of the effects of green tea consumption on HDL cholesterol as compared with the control arms. Sizes of the data markers
indicate the weight of each study in the analysis. WMD, weighted mean difference (the result was obtained from a fixed-effects model).

amounts of LDL-receptor protein. In addition, there is another
possible major mechanism by which green tea lowers cholesterol:
catechins have direct inhibitory effects on cholesterol synthesis.
A recent in vitro study has revealed that green tea catechins were
potent and selective inhibitors of squalene epoxidase, which is
likely a rate-limiting enzyme of cholesterol biosynthesis (43).
These effects of green tea are similar to hypocholesterolemic
drugs such as statins, which reduce cholesterol synthesis and
increase the LDL receptor (44).
The effect of green tea beverages and green tea extract on blood
lipid profiles has been investigated in vitro and in vivo, including in
studies in both animals and humans, by many researchers. Hsu et al
(17) have revealed that green tea intakes significantly decreased
LDL-cholesterol concentrations and markedly increased concen-
trations of HDL cholesterol. Consistent with this study, other
studies showed that green tea consumption was able to reduce
serum cholesterol concentrations (11, 14, 19, 21, 23). In contrast,
several studies reported that there were no positive correlations
between green tea intake and reduced blood cholesterol concen-
trations (12, 13, 16, 24). To clarify the precise effect of green tea on
serum cholesterol, we conducted the current meta-analysis of
published RCTs. The results indicated that green tea beverages and
green tea extract supplementation significantly reduced TC and
LDL-cholesterol concentrations. The results of this study were
consistent with a recently published meta-analysis that showed that
green tea significantly reduced LDL-cholesterol concentrations
(45). Furthermore, a recent study conducted in Japanese children
showed that the consumption of a catechin-rich beverage for 24 wk
significantly decreased LDL cholesterol after a 12-wk follow-up
(46). To our knowledge, this study provided new evidence, which
supported the conclusion of our meta-analysis, that green tea has
hypocholesterolemic properties.
These results suggested that green tea may be incorporated into
a targeted dietary program as part of public health policy to im-
prove cardiovascular health. Because most Americans drink high-
calorie beverages or alcohol on a daily basis, and only 20% of
Americans consume low-calorie green tea (47), the potential for
meaningful intervention is real.
 608

TABLE 3
Subgroup analyses of total, LDL, and HDL cholesterol stratified by previously defined study characteristics
Total cholesterol LDL cholesterol HDL cholesterol

No. of Mean difference P for No. of Mean difference P for No. of Mean difference P for
Variables trials (95% CI) heterogeneity trials (95% CI) heterogeneity trials (95% CI) heterogeneity

mg/dL mg/dL mg/dL

Subgroup analysis
Type of intervention
Green tea beverage 6 27.56 (28.61, 26.52) 0.288 5 21.82 (22.86, 20.78) 0.549 5 20.57 (21.93, 0.78) 0.229
Green tea capsule 8 23.89 (27.05, 20.72) 0.843 6 25.19 (28.15, 22.23) 0.313 7 1.16 (20.27, 2.58) 0.576
Catechins dose
,625 mg/d (low median) 6 23.51 (26.41, 20.61) 0.726 5 25.36 (27.99, 22.73) 0.796 5 0.07 (21.14, 1.29) 0.236
625 mg/d (high median) 8 27.69 (28.75, 26.64) 0.731 6 21.68 (22.73, 20.62) 0.388 7 0.57 (21.09, 2.23) 0.270
Healthy status
Healthy 6 23.26 (26.61, 0.08) 0.809 4 25.28 (28.14, 22.14) 0.710 4 20.49 (22.84, 1.87) 0.784
ZHENG ET AL

With cardiovascular risks 8 27.58 (28.62, 26.54) 0.519 7 21.85 (22.88, 20.83) 0.246 8 0.40 (20.68, 1.48) 0.106
Duration
,12 wk (low median) 7 23.19 (26.40, 0.02) 0.899 5 24.77 (27.77, 21.77) 0.742 5 0.05 (21.80, 1.90) 0.650
12 wk (high median) 7 27.63 (28.67, 26.58) 0.489 6 21.88 (22.91, 20.85) 0.142 7 0.32 (20.83, 1.48) 0.094
Jadad score
Low (2 or 3) 11 27.55 (28.58, 26.52) 0.617 8 21.89 (22.92, 20.87) 0.789 10 20.07 (21.12, 0.98) 0.300
High (4 or 5) 3 23.05 (26.62, 0.53) 0.758 3 25.25 (28.54, 21.95) 0.053 3 2.36 (20.36, 5.08) 0.833
Sensitivity analysis
High-quality studies 3 23.05 (26.62, 0.53) 0.758 3 25.25 (28.54, 21.95) 0.053 3 2.36 (20.36, 5.08) 0.833
Studies did not receive industry funding 13 27.16 (28.16, 26.17) 0.359 11 22.19 (23.16, 21.21) 0.201 11 0.06 (20.98, 1.11) 0.263

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 GREEN TEA LOWERS CHOLESTEROL
Although we believe that the current meta-analysis provided
useful information, some potential limitations should be addressed.
First, an obvious source of conflict was that there is no general
agreement on what quantity constitutes a cup of green tea. Doses of
green tea catechins in the 14 trials involved in our meta-analysis
ranged from 150 to 2500 mg/d (median: 625 mg/d). The wide
range of green tea catechin doses made it difficult to determine the
optimal dose that would most improve the blood lipid profile.
Second, caffeine is naturally contained in green tea. A newly
released study showed that coffee consumption led to an increase
in serum concentrations of TC and HDL cholesterol, mainly
because of caffeine (48). In our meta-analysis, 11 trials stated that
green tea beverages or extracts contained caffeine in the in-
tervention groups. The independent effect of caffeine might have
been a confounding factor that influenced the results of this meta-
analysis.
Third, the quality of the trials included in our meta-analysis
varied from low to high. Of the 14 trials, only 3 trials (12, 17, 23)
were high-quality studies (Jadad score 4), whereas the other
studies were low quality. Meanwhile, the study durations were
short (from 3 wk to 3 mo). Therefore, more high-quality and long-
term (over years) randomized studies are needed in the future.
Fourth, our meta-analysis did not pool safety data because no
serious side effects were reported in these involved trials. However,
concern has been raised as to the safety of supplementation with
high doses of green tea polyphenols. In mice, the intraperitoneal
injection of green tea catechins increased plasma concentrations of
alanine transaminase (49). In addition, clinical reports have shown
that green tea was the major dietary source of oxalate in some
patients who presented with kidney oxalate stones (50). Daily
green tea consumption in the current meta-analysis was equivalent
to 18 cups, and the trials varied in length from 3 wk to 3 mo,
and no subjects experienced major adverse events. This phe-
nomenon may be attributed to the following 2 factors: 1) the
durations of studies involved in our meta-analysis were not long
enough to observe serious side effects, and 2) consumption of
,18 cups of green tea/d may be not enough to cause adverse
effects. Therefore, safety issues need to be evaluated in the future
under conditions of long-term and high-dose exposure.
In conclusion, green tea significantly reduced serum total and
LDL-cholesterol concentrations, and the changes were not influenced
by the type of intervention, treatment doses of green tea catechins,
study duration, individual health status, or quality of the study. For
intervention groups, the mean change in blood HDL-cholesterol
concentrations showed a favorable trend, but it was not significant.
We thank Lei Jia for her assistance and BioMed Proofreading for their text
editing.
The authors’ responsibilities were as follows—X-XZ, Y-LX, RH, and
X-HH: conceived the idea of the study and designed the study strategy;
X-XZ and Y-LX: summarized data and conducted data analyses; and all
authors: contributed to data analyses and the writing and revision of the man-
uscript. None of the authors declared a conflict of interest.
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